The Government of Tajikistan has initiated a range of health reforms over the last decade to advance Universal Health Coverage and strengthen primary health care. These steps are particularly needed to help reduce the country’s high burden of non-communicable diseases. As First Deputy Minister of Health Gafur Muhsinzoda noted in remarks at the 2020 World Health Summit, “Stronger primary health care allows us to make better use of limited resources, reduce the burden on hospitals and better serve the poor and people in rural areas. COVID-19 has further highlighted the need for us to strengthen primary care”. Major reforms include development of a state-guaranteed Basic Benefit Package, introduction of a per capita health financing approach for more equitable distribution of resources at the primary health care level, piloting a performance-based financing mechanism, case-based hospital payments and legislation to establish a Mandatory Health Insurance Fund.
The training of family nurses and doctors at the Republican Centre for Family Medicine on detecting and managing hypertension and prevention of cardiovascular diseases in the delivery of primary health care services, Tajikistan. ©WHO/Mekhri Shoismatuloeva
GAP signatory agencies in Tajikistan have provided significant support to these efforts in recent years. GFF and WHO, for example, helped to support development of the health financing chapter of the new National Health Strategy 2021-2030 in which reform of the existing health financing system is regarded as an essential step towards improving the efficiency of health service delivery and addressing issues related to equity, access and affordability of PHC. In 2019, the Bank and Gavi joined forces to co-finance activities to increase coverage and quality of basic PHC in selected districts and support the nationwide rollout of per capita financing for PHC. In the same year, Tajikistan became the first country in Europe or Central Asia to join the GFF and GFF co-financing in the World Bank’s Early Childhood Development Project is providing incentives to introduce and implement nationwide program-based budgeting for PHC. WHO has been supporting health system governance, public financial management and roll-out of the Basic Benefit Package. Among other partners, the European Union has funded a new programme supporting health systems strengthening with a focus on capacity development in the Ministry of Health and planning and delivery mechanisms for primary health care.
As noted in a report on Tajikistan’s progress towards the health-related SDGs published by the WHO Regional Office for Europe in November 2020, additional efforts are needed to accelerate implementation of the country’s health reforms. Since mid-2019, the World Bank has led monthly calls open to a sub-group of partners with a specific interest in financing from the Health Working Group of Tajikistan’s Donor Coordination Council, which is co-chaired by WHO and the European Union, to promote better information-sharing and understanding of each other’s work in the country. This group – which includes several agencies active in the GAP sustainable financing for health (SFH) accelerator working group – played a key role in supporting the Government as it developed its COVID-19 Country Preparedness and Response Plan in March 2020, including through a time-limited sub-group which met weekly to share information and monitor progress on procurement of supplies and equipment. With support from partners in this group, Tajikistan was among the first countries to hold cross-agency COVID-19 vaccine readiness discussions in October 2020.
The GAP SFH accelerator working group has recognized Tajikistan’s early and proactive response to the COVID-19 pandemic and shared information about it with other countries and partners as part of the working group’s ongoing efforts around knowledge sharing and cross learning.
While the pandemic has delayed further significant progress on health reforms, members of the GAP SFH accelerator working group and the national-level partner Health Working Group aim to build on closer collaboration during the pandemic response to help the country resume progress towards the health-related SDGs. Key opportunities include:
- Finalization of the draft National Health Strategy, including development of a health sector investment case and a Prioritized Operational Plan;
- Further technical support and capacity building, such as extension of the per capita financing approach in primary health care with increased autonomy for PHC facilities; wider use of disbursement-linked indicators for public financial management in PHC; and introduction of incentives for implementing the basic package of health services; and
- Strengthening public financial management, building upon collaboration between the country and the World Bank, WHO and the European Union.